As first enrollment date near, new survey underscores confusion, challenges to seniors...Many seniors say they don't understand the plan, don't know if they will enroll, and are wary of the large number of Plan choices

WASHINGTON, D.C. – With the new Medicare drug benefit’s open enrollment period set to begin Nov. 15, many seniors remain uncertain about how the law will affect them and unsure about whether they will enroll, according to a new survey by the Kaiser Family Foundation and the Harvard School of Public Health. The results highlight the critical importance of ongoing education efforts to successful implementation of the new program next year.

When asked how well they understand the drug benefit, more than six in 10 seniors (61%) say “not too well” or “not at all,” while more than one in three seniors (35%) say “very” or “somewhat” well. When asked whether the Medicare drug benefit would help them personally, more seniors say it would not (49%) than say it would (39%).

Overall, more than four in 10 seniors (43%) report they do not yet know if they will enroll in a Medicare drug plan for 2006; 37% say they do not plan to enroll; and one in five (20%) say they plan to enroll. Seniors without any drug coverage are most likely to say that they plan to enroll (28%, compared with 15% for those with existing drug coverage).

Most seniors substantially underestimate the number of drug plan choices that they will have, with just 5% correctly identifying that they will have more than 20 options for receiving their drug coverage. When informed that “the government has announced that most people on Medicare will have at least 40 different drug plans to choose from,” almost three in four (73%) say that having many plans “makes it confusing and difficult to pick the best plan,” while 22% say it is “helpful and provides an opportunity to choose the best plan.”

“In the next six months, the question is whether seniors stay on the sidelines or enroll in drug plans in large numbers. In the long run the bigger question is whether seniors believe they are getting enough help with their drug costs from the plans they are in,” Foundation President Drew E. Altman, Ph.D., said.

The nationally representative survey - the ninth in a series tracking the views of people with Medicare - finds that seniors are about split in their overall views of the drug benefit (37% have an unfavorable view, 31% favorable, and 31% don’t know). Seniors who say they understand the benefit well are far more likely to report favorable views (47% favorable), compared with 21% favorable among those who say they do not understand it well.

While three in four seniors (77%) say that the drug benefit will help people with low incomes, many of those who might qualify for additional low-income assistance do not realize it. Among the group of seniors most likely to be eligible (those who earn less than $15,000 annually), half (50%) do not know that they are likely to be eligible for additional financial help.

Among seniors who plan to enroll, 35% say that how much they would pay out of pocket for each prescription is most important to their decision about choosing a plan, compared with 19% who say “which drugs the plans cover” and 16% who say “how much the plan charges for monthly premiums.” One in five (20%) say that all those factors are important, and the others did not know.

“Seniors are saying that they care more about how much they will pay out of pocket for each prescription drug than they do about premiums and formularies,” said Robert J. Blendon, Sc.D., Professor of Health Policy at the Harvard School of Public Health. “That could influence their decisions as they choose a drug plan.”

The survey shows varying degrees of knowledge among seniors related to key elements of the new benefit. For example, nearly two in three seniors (64%) say correctly that, in general, seniors must sign up to get coverage, but one in 10 (10%) incorrectly say coverage would begin automatically and one in four (25%) say they don’t know. In addition, more than four in 10 seniors either say that they don’t know if there are financial penalties for late enrollment (27%) or say incorrectly that there are no such penalties (19%).

In making decisions about the drug benefit, seniors most often say that they “very likely” would turn to the Medicare program (33%) or their personal doctor (32%) for help. Smaller shares say that they are “very likely” to seek help from their pharmacist (25%), Social Security (24%), friends and family members (20%), or a seniors’ group or community organization (16%).

More than half of all seniors say that their pharmacists (55%) and doctors (53%) are “very” or “somewhat” likely to spend time to help them choose a drug plan. Three in four (75%) say that they expect their pharmacists to be “very” or “somewhat” knowledgeable about their drug plan choices, while nearly two thirds (65%) say the same about their physicians.

“Many seniors expect to lean heavily on their doctors and pharmacists to help guide them through their many options,” said Kaiser Family Foundation Vice President Mollyann Brodie, Ph.D., the director of the Foundation’s Public Opinion and Media Research. “If this proves unrealistic, their frustration could create an implementation challenge.”

The survey shows that seniors increasingly are receiving information or hearing about the Medicare drug benefit. About three in four seniors (74%) say that they have received information about the new Medicare drug benefit, and of those, six in 10 (60%) say that they read through it closely. Nearly half (47%) say they had received information from the Centers for Medicare & Medicaid Services, which runs the benefit up from about one in four (26%) who said so in August.

More than four in 10 seniors (45%) say they have seen or heard advertisements about the drug benefit on television or radio. Of those, more than half (51%) say that the ads were primarily “trying to educate seniors about the new drug benefit generally,” while more than a third (37%) say the ads were mainly “trying to get seniors to sign up for a specific drug plan.”

The survey also finds that half of seniors (50%) have heard of 1-800-MEDICARE and slightly more than a third (35%) have heard of the government web site.  The telephone number and Web site are maintained by the Centers for Medicare & Medicaid Services to help beneficiaries understand the program and the drug benefit in particular. In addition, about three in four seniors (76%) say that they have never gone online to use the Internet. Overall, 8% of seniors say that they have called 1-800-MEDICARE for assistance, and 6% say they have visited the website.